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NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN <br /> EXTENSIONS FOR PWSs <br /> Proiect Name : 92nd Court Waterline Extension Permittee : N/A <br /> D. Certification by Professional Engineer(s) in Responsible Charge of Designing Project* <br /> 1 , the undersigned professional engineer licensed in Florida, am in responsible charge of designing this project. I certify that, <br /> to the <br /> best of my knowledge and belief, the design of this project complies with Chapter 62-555 , F.A.C . 1 also certify that, to the best <br /> of <br /> my knowledge and belief, this project is not being designed to include any of the following construction work: <br /> • construction of water mains conveying raw or partially treated drinking water; <br /> • construction of drinking water treatment, pumping, or storage facilities or conflict manholes; <br /> • construction of water mains in areas contaminated by low-molecular-weight petroleum products or organic solvents , <br /> • construction of an interconnection between previously separate public water systems or construction of water mains that create <br /> a "new system " as described under subsection 62-555 . 525 ( 1 ), F . A .C . ; or <br /> • construction of water mains that will remain dry following completion of construction . <br /> (A specific construction permit is required for each project involving any of the above listed construction work.) <br /> Signature , Seal , and Date: Signature , Seal , and Date : <br /> kA%% 1H1111l11/d//d <br /> BOtrz <br /> 0 �F <br /> NSF <br /> � r <br /> N <br /> 55313 <br /> _ o <br /> -o ATE OF <br /> W " <br /> RN <br /> F �Al <br /> Printed/T ed Name: WIMM"IT 13owles, P.E. Printed/Typed Name: <br /> License Number: 55313 - License Number: <br /> Portion of Preliminary Design Report for Which Responsible: Portion of Preliminary Design Report for Which Responsible : <br /> Entire Project <br /> * Except as noted in paragraphs 62-555. 520(3) (a) and (b), F.A . C. , projects shall be designed under the responsible charge of one <br /> or more professional engineers (PEs) licensed in Florida. If this project is being designed under the responsible charge of one <br /> or more PEs licensed in Florida, Part IIID of this notice shall be completed by the PE(s) in responsible charge. If this project <br /> is not being designed under the responsible charge of one or more PEs licensed in Florida, Part Ill. D does not have to be <br /> completed. <br /> DEP Form 62-555.900(7)AUternate Page 8 <br /> Effective August 28. 2003 <br />